Connecticut requires infertility insurance coverage for those over 40

HARTFORD, Conn. — People over 40 who still hope to become parents in Connecticut may soon have the cost of infertility treatments covered by their insurance company.

The state Department of Insurance has determined that a 2006 state law mandating coverage for medically appropriate fertility treatments for men and women is discriminatory because it sets an age limit of 40.

“At the time, there was medical evidence to support stopping it at 40. But we need to keep up with the times,” said Insurance Commissioner Katharine Wade, adding how new technologies and procedures have been proven to be clinically effective, making it more possible for older people to conceive a child.

Wade’s office on Friday issued a bulletin to insurance companies and health care centers, informing them they must remove the age limit on infertility benefits for policies sold or renewed on or after Jan. 1, 2016. In April, the Washington, D.C.-based National Women’s Law Center released a report that found numerous violations of the Affordable Care Act regarding requirements for women’s health coverage in 15 states, including Connecticut. The federal act prohibits discrimination in health care.

Karen Davenport, director of health policy at the center, said Connecticut was one of a handful of states that required coverage for infertility treatment but imposed the 40-year age limit. She praised the state for lifting it.

“The Connecticut Department of Insurance was really open to hearing our arguments,” she said.

Under the revised rule, men and women receiving infertility treatments still must be healthy and the treatment must be medically necessary in order to be covered. According to the bulletin issued by the agency, carriers and physicians may use “reasonable medical management” to determine if an individual is healthy or if the treatment is medically necessary.

Wade said there are tests available that can help determine whether infertility treatment will work for a woman.

Keith Stover, a lobbyist for the Connecticut Association of Health Plans, said the health insurers support the change.

“It’s a positive development handled exactly the right way by the insurance commissioner,” he said. “We were asked to discuss, we brought our experts to the table and worked out a sound and rational approach to the issue.”

It’s unclear how many people may ultimately be helped by the change in Connecticut’s policy. But Susan Yolen, vice president of public policy and advocacy for Planned Parenthood of Southern New England, said more women are choosing to become mothers later in life.

“While we most often think of family planning as pregnancy prevention for younger women,” she said, “there are an increasing number of women who choose parenthood later in their reproductive lives, only to experience infertility.”

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maineincrisis

Dumb!!! State mandates should be superseded by federal mandates so insurance can be sold across state lines. 40 year olds don’t need to be having kids. You shouldn’t be on Medicare and going to your kids jr high graduation….

Trisha

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